Research Interests: Medical Microbiology, Biology, Medicine, Clinical Microbiology, Biological Sciences, and 13 moreHumans, Clinical, Infant, Newborn Infant, C reactive protein, Bacterial Load, Bronchopulmonary Dysplasia, Ureaplasma Urealyticum, Premature Birth, Medical and Health Sciences, Ureaplasma, multiplex polymerase chain reaction, and Respiration Artificial
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ImportanceThe long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified.ObjectiveTo examine... more
ImportanceThe long-term effects of surfactant administration via a thin catheter (minimally invasive surfactant therapy [MIST]) in preterm infants with respiratory distress syndrome remain to be definitively clarified.ObjectiveTo examine the effect of MIST on death or neurodevelopmental disability (NDD) at 2 years’ corrected age.Design, Setting, and ParticipantsFollow-up study of a randomized clinical trial with blinding of clinicians and outcome assessors conducted in 33 tertiary-level neonatal intensive care units in 11 countries. The trial included 486 infants with a gestational age of 25 to 28 weeks supported with continuous positive airway pressure (CPAP). Collection of follow-up data at 2 years’ corrected age was completed on December 9, 2022.InterventionsInfants assigned to MIST (n = 242) received exogenous surfactant (200 mg/kg poractant alfa) via a thin catheter; those assigned to the control group (n = 244) received sham treatment.Main Outcomes and MeasuresThe key secondar...
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IntroductionRespiratory distress syndrome is a condition seen in preterm infants primarily due to surfactant insufficiency. European guidelines recommend the dose and method of surfactant administration. However, in routine practice,... more
IntroductionRespiratory distress syndrome is a condition seen in preterm infants primarily due to surfactant insufficiency. European guidelines recommend the dose and method of surfactant administration. However, in routine practice, clinicians often use a ‘whole vial’ approach to surfactant dosing. The aim of this study is to assess whether in preterm infants of gestational age 36+6weeks+daysor less, a low first dose of surfactant (100–130 mg/kg) compared with a high first dose (170–200 mg/kg) affects survival with no mechanical ventilation on either on postnatal days 3 and 4, and other outcomes.Methods and analysisIn this prospective, observational study, we will use the National Neonatal Research Database as the main data source. We will obtain additional information describing the dose and method of surfactant administration through the neonatal EPR system. We will use propensity scores to form matched groups with low first dose and high first dose for comparison.Ethics and diss...
Research Interests: Management, Internal Medicine (General Medicine), General Internal Medicine, Failure, Neonatology, and 12 moreMedicine, Clinical Sciences, Public health systems and services research, Science Technology, Gestational Age, CPAP, Observational Study, Pulmonary Surfactant, Respiratory distress, Life Sciences & Biomedicine, Dosing, and Positive airway pressure
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IntroductionEx‐preterm infants with severe bronchopulmonary dysplasia (BPD) sometimes require long‐term ventilation (LTV) to facilitate weaning from respiratory support. There are however limited data characterizing this cohort. We aim to... more
IntroductionEx‐preterm infants with severe bronchopulmonary dysplasia (BPD) sometimes require long‐term ventilation (LTV) to facilitate weaning from respiratory support. There are however limited data characterizing this cohort. We aim to describe the background characteristics, neonatal comorbidities, characteristics at the initiation of ventilation, and outcomes of neonatal unit graduates with BPD established on LTV.MethodsA retrospective cohort study of infants born <32 weeks gestation with BPD referred to a regional LTV service between January 2015 and December 2020.ResultsTwenty‐five infants were referred during the study period. Median birth gestation was 26 + 1 weeks (24 + 0–30 + 4) and birth weight 645 g (430–1485). At 36 weeks postmenstrual age (PMA), median FiO2 was 0.45 (0.24–0.80) and one‐quarter of infants remained on invasive ventilation. Twenty (80%) infants were established on noninvasive ventilation (NIV), with the smallest weighing 2085 g, and five (20%) require...
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ABSTRACTBackgroundLipid metabolism in pregnancy delivers PUFAs from maternal liver to the developing fetus. The transition at birth to diets less enriched in PUFA is especially challenging for immature, extremely preterm infants who are... more
ABSTRACTBackgroundLipid metabolism in pregnancy delivers PUFAs from maternal liver to the developing fetus. The transition at birth to diets less enriched in PUFA is especially challenging for immature, extremely preterm infants who are typically supported by total parenteral nutrition.ObjectiveThe aim was to characterize phosphatidylcholine (PC) and choline metabolism in preterm infants and demonstrate the molecular specificity of PC synthesis by the immature preterm liver in vivo.MethodsThis MS-based lipidomic study quantified the postnatal adaptations to plasma PC molecular composition in 31 preterm infants <28 weeks’ gestational age. Activities of the cytidine diphosphocholine (CDP-choline) and phosphatidylethanolamine-N-methyltransferase (PEMT) pathways for PC synthesis were assessed from incorporations of deuterated methyl-D9-choline chloride.ResultsThe concentration of plasma PC in these infants increased postnatally from median values of 481 (IQR: 387–798) µM at enrollmen...
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While introduction of exogenous surfactant therapy has dramatically improved survival of infants born 23–28 weeks gestation, the turnover of exogenous and synthesis of endogenous surfactant components are poorly understood in this... more
While introduction of exogenous surfactant therapy has dramatically improved survival of infants born 23–28 weeks gestation, the turnover of exogenous and synthesis of endogenous surfactant components are poorly understood in this group.Additionally, up to 40% of survivors will develop neonatal chronic lung disease (nCLD), but little is known about the contribution of continued surfactant dysfunction to its cause. A variety
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Research Interests: Microbiology, Biology, Medicine, Perinatal Medicine, Humans, and 15 moreBacteria, Staphylococcus aureus, Obstetrics and Gynaecology, Risk factors, Pseudomonas aeruginosa, Clinical Sciences, Newborn Infant, Streptococcus, Bacterial infections, Risk Factors, Bronchopulmonary Dysplasia, Pseudomonas Aeruginosa, Moraxella Catarrhalis, Paediatrics and reproductive medicine, and Infant Premature
Multiplex, real-time PCR for the identification of Ureaplasma urealyticum and Ureaplasma parvum was performed on nucleic acids extracted from sequential endotracheal aspirates obtained from preterm neonates born at <29 weeks of... more
Multiplex, real-time PCR for the identification of Ureaplasma urealyticum and Ureaplasma parvum was performed on nucleic acids extracted from sequential endotracheal aspirates obtained from preterm neonates born at <29 weeks of gestation and ventilated for more than 48 h admitted to two level 3 neonatal intensive care units. Specimens were obtained shortly after birth and sequentially up until extubation. One hundred fifty-two specimens (93.8%) contained material suitable for analysis. Ureaplasma spp. were identified in 5 of 13 neonates studied. In most cases, the DNA load of the detected Ureaplasma species was low and decreased over time. In addition, changes in detectable Ureaplasma species DNA did not relate to changes in the inflammatory marker C-reactive protein (CRP) or respiratory status. All but two blood samples obtained at times of suspected sepsis were culture positive for other microorganisms; the species cultured were typically coagulase-negative staphylococci and we...
Research Interests: Medical Microbiology, Biology, Medicine, Clinical Microbiology, Biological Sciences, and 13 moreHumans, Clinical, Infant, Newborn Infant, C reactive protein, Bacterial Load, Bronchopulmonary Dysplasia, Ureaplasma Urealyticum, Premature Birth, Medical and Health Sciences, Ureaplasma, multiplex polymerase chain reaction, and Respiration Artificial
The role of infection in bronchopulmonary dysplasia (BPD) is unknown. We present an observational study of 55 premature infants born weighing less than 1.3 kg within two level III neonatal intensive care units. Endotracheal aspirates... more
The role of infection in bronchopulmonary dysplasia (BPD) is unknown. We present an observational study of 55 premature infants born weighing less than 1.3 kg within two level III neonatal intensive care units. Endotracheal aspirates (ETA) and nasogastric aspirates (NGA) were studied with denaturing gradient gel electrophoresis (DGGE) profiling to elucidate the total bacterial community, and species-specific PCR was used to detect the presence of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum. DGGE identified bacterial species in 59% of NGA and ETA samples combined. A diverse range of species were identified including several implicated in preterm labor. Species-specific PCR identified M. hominis in 25% of NGA and 11% of ETA samples. Among the 48 infants surviving up to 36 wk-postconceptual age, ordinal logistic regression showed the odds ratio for BPD or death where Ureaplasma was present/absent as 4.80 (95% CI 1.15-20.13). After adjusting for number of days vent...